Catalina Balaguer

Low erythropoietin plasma levels during exacerbations of COPD.

Background: It is known that pro-inflammatory cytokines suppress in vitro the gene expression and protein production of erythropoietin (Epo). We hypothesized that systemic inflammation in patients with chronic obstructive pulmonary disease (COPD) may influence Epo production, particularly during episodes of exacerbation of the disease (ECOPD) where an inflammatory burst is known to occur. Objectives: We compared the plasma levels of Epo and high-sensitivity (hs) C-reactive protein (hsC-RP) in patients hospitalized because of ECOPD (n = 26; FEV1: 48 ± 15% predicted), patients with clinically stable COPD (n = 31; FEV1: 49 ± 17% predicted), smokers with normal lung function (n = 9), and healthy never smokers (n = 9). Methods: Venous blood samples were taken between 9 and 10 a.m. after an overnight fast into tubes with EDTA (10 ml) or without EDTA (10 ml). Plasma levels of Epo (R&D Systems Inc., Minneapolis, Minn., USA) and hsC-RP (BioSource, Belgium) were determined by ELISA. Results: Log-Epo plasma levels were significantly lower (0.46 ± 0.32 mU/ml) in ECOPD than in stable COPD (1.05 ± 0.23 mU/ml), smokers (0.95 ± 0.11 mU/ml) and never smokers with normal lung function (0.92 ± 0.19 mU/ml) (p < 0.01, each). In a subset of 8 COPD patients who could be studied both during ECOPD and clinical stability, log-Epo increased from 0.49 ± 0.42 mU/ml during ECOPD to 0.97 ± 0.19 mU/ml during stability (p < 0.01). In patients with COPD log-Epo was significantly related to hsC-RP (r = –0.55, p < 0.0001) and circulating neutrophils (r = –0.48, p < 0.0001). Conclusions: These results show that the plasma levels of Epo are reduced during ECOPD likely in relation to a burst of systemic inflammation.

Tabaco y trastornos del sueño

Snoring and sleep apnea-hypopnea syndrome (SAHS) are two disorders of considerable relevance due to their high prevalence in the general population and their notable morbidity and mortality, particularly in association with their harmful effects on the cardiovascular system. As well as sex, age, weight, craniofacial malformations, alcohol consumption, and use of hypnotic drugs, it has been suggested that smoking may be a risk factor for developing sleep-disordered breathing. While there is solid evidence for the independent association between snoring and smoking in both children and adults, it is still unclear whether smoking constitutes an independent risk factor for developing SAHS, despite the many studies carried out to assess this link. This is probably because the association, if it exists, is very weak.

Actividad de una unidad de cuidados respiratorios intermedios dependiente de un servicio de neumología

BACKGROUND AND OBJECTIVE With the development of noninvasive ventilation (NIV), patients with increasingly complex needs have been admitted to respiratory medicine departments. For this reason, such departments in Spain and throughout Europe have been adding specialized respiratory intermediate care units (RICUs) for monitoring and treating patients with severe respiratory diseases. The aim of the present study was to describe the activity of such a RICU. The description may be of use in facilitating the setting up of RICUs in other hospitals of the Spanish National Health Service. METHODS A systematic record of activity carried out in the RICU of the Hospital Universitario Son Dureta between January and December 2006 was kept prospectively. RESULTS Of 206 patients with a mean (SD) age of 65 (14) years admitted to the unit, 67% came from the emergency department, 14% from the respiratory medicine department, and 12% from the intensive care unit (ICU). The most common admission diagnoses were exacerbated chronic obstructive pulmonary disease (COPD) (n=97, 47.1%), pneumonia (n=39, 18.9%), heart failure (n=17, 8.2%), and pulmonary vascular diseases (n=18, 8.7%). One hundred twenty-one patients (59%) required NIV. Mean length of stay in the RICU was 5 (5) days. Patients were discharged to the conventional respiratory ward in 79.1% of the cases; 7.8% required subsequent admission to the ICU, and 9.7% died. Of the patients with exacerbated COPD (mean age, 66.5 [10] years; mean length of stay, 4.6 [4.5] days), 67% required NIV, 7.2% required subsequent admission to the ICU, and 8.2% died. CONCLUSIONS The creation of a RICU by a respiratory medicine department is viable in Spain. Such units make it possible to treat a large number of patients with a low rate of therapeutic failures. Exacerbated COPD was the most common diagnosis on admission to our RICU, and the need for NIV the most common criterion for admission.

Activity of an Intermediate Respiratory Care Unit Attached to a Respiratory Medicine Department

Abstract Background and objective With the development of noninvasive ventilation (NIV), patients with increasingly complex needs have been admitted to respiratory medicine departments. For this reason, such departments in Spain and throughout Europe have been adding specialized respiratory intermediate care units (RICUs) for monitoring and treating patients with severe respiratory diseases. The aim of the present study was to describe the activity of such a RICU. The description may be of use in facilitating the setting up of RICUs in other hospitals of the Spanish National Health Service. Methods A systematic record of activity carried out in the RICU of the Hospital Universitario Son Dureta between January and December 2006 was kept prospectively. Results Of 206 patients with a mean (SD) age of 65 (14) years admitted to the unit, 67% came from the emergency department, 14% from the respiratory medicine department, and 12% from the intensive care unit (ICU). The most common admission diagnoses were exacerbated chronic obstructive pulmonary disease (COPD) (n= 97, 47.1%), pneumonia (n=39, 18.9%), heart failure (n=17, 8.2%), and pulmonary vascular diseases (n=18, 8.7%). One hundred twenty-one patients (59%) required NIV. Mean length of stay in the RICU was 5 (5) days. Patients were discharged to the conventional respiratory ward in 79.1% of the cases; 7.8% required subsequent admission to the ICU, and 9.7% died. Of the patients with exacerbated COPD (mean age, 66.5 [10] years; mean length of stay, 4.6 [4.5] days), 67% required NIV, 7.2% required subsequent admission to the ICU, and 8.2% died. Conclusions The creation of a RICU by a respiratory medicine department is viable in Spain. Such units make it possible to treat a large number of patients with a low rate of therapeutic failures. Exacerbated COPD was the most common diagnosis on admission to our RICU, and the need for NIV the most common criterion for admission.

Impacto de la presencia de un neumólogo de guardia sobre la actividad de un servicio de neumología

Objetivo Analizar que impacto asistencial y de gestion clinica tiene la implantacion de guardias de presencia fisica continuada en un servicio de neumologia. Metodos En febrero de 2004 se introdujeron las guardias de neumologia en el Hospital Universitario Son Dureta. Durante un ano, hasta enero de 2005, se recogio de forma prospectiva y sistematica la actividad realizada por el/la neumologo/a de guardia. Con objeto de situar estos resultados en perspectiva, se ha comparado el numero de ingresos mensuales y su estancia media durante los 12 meses en que se ha dispuesto de guardia de neumologia y los 12 meses inmediatamente anteriores. Resultados Durante los 12 meses evaluados, el/la neumologo/a de guardia recibio una media ± desviacion estandar de 9,02 ± 5,27 avisos urgentes cada dia, realizo 202 tecnicas diagnosticas/terapeuticas y dio de alta a 342 pacientes. Durante este periodo ingresaron en el servicio 1.305 pacientes (estancia media: 8,1 dias), mientras que en los 12 meses previos, sin guardia de la especialidad, habian ingresado en el servicio 1.680 pacientes (estancia media: 9,0 dias); esto supone una reduccion del 22,3% del numero anual de ingresos y una disminucion de la estancia media de los pacientes ingresados de practicamente un dia (0,9 dias). Conclusiones La implantacion de guardias de neumologia ha sido una medida eficiente, que ha contribuido a agilizar la rotacion de los pacientes ingresados.

Effects of simvastatin in chronic obstructive pulmonary disease: Results of a pilot, randomized, placebo-controlled clinical trial

Introduction Statins may have pleiotropic effects in COPD, but mechanisms remain unclear. Objectives To assess the pleiotropic effect of statins in patients with stable COPD on (1): lung function (2); pulmonary and systemic inflammation (3); endothelial function (vascular stiffness) and circulating vascular growth factors; and (4), serum uric acid levels. Method Pilot, double-blind, randomized, placebo-controlled clinical trial in 24 patients with stable COPD, all statin-naïve, who were randomized (1:1) to receive simvastatin 40 mg/24 h during 12 weeks (n = 12; 69.0 ± 7.3 years; post-bd FEV1 53.4 ± 10.0% pred.) or placebo (n = 12; 66.4 ± 4.6 years; post-bd FEV1 48.2 ± 12.6% pred.). Nine patients per group (total n = 18) completed the study. Results Lung function, pulmonary and systemic inflammatory markers and the degree of vascular stiffness did not change significantly in any group. However, treatment with simvastatin increased the plasma levels of erythropoietin (Epo) (4.2 ± 2.2 mIU/mL to 6.8 ± 3.2 mlU/mL, p < 0.05) and reduced those of serum uric acid (7.1 ± 1.3 mg/dL to 6.5 ± 1.4 mg/dL, p < 0.01). Conclusions Short-term treatment with simvastatin in stable COPD patients did not modify lung function, pulmonary and systemic inflammation, or vascular stiffness, but it changed Epo and uric acid levels.

[Impact of an on-duty pulmonologist on the activity of a respiratory medicine department].

OBJECTIVE To evaluate the impact on health care and clinical management of 24-hour coverage by an on-site pulmonologist in a respiratory medicine department. METHODS In February 2004, a new respiratory medicine 24-hour duty service was started in our hospital. The activity of the on-duty pulmonologist during the following 12 months was systematically and prospectively recorded. The results were put into perspective by comparing the number of monthly admissions and the mean length of stay during the study period with those of the previous 12-month period. RESULTS During the study period, the on-duty pulmonologist received a mean (SD) of 9.02 (5.27) emergency calls every day, performed 202 diagnostic or therapeutic interventions, and discharged 342 patients. During this period, 1305 patients were admitted to the department (mean length of stay, 8.1 days), whereas in the previous 12 months, with no on-site pulmonologist, 1680 patients were admitted (mean length of stay, 9.0 days). This represents a 22.3% reduction in the annual number of admissions and a reduction in the mean stay by almost 1 day (0.9 days). CONCLUSIONS The provision of an on-duty pulmonologist was efficient because it facilitated patient turnaround.